Restrictive lung diseases or restrictive ventilatory defects
Restrictive lung disease is a condition marked most obviously by a reduction in total lung capacity. A restrictive ventilatory defect may be caused by a pulmonary deficit, such as pulmonary fibrosis (abnormally stiff, non-compliant lungs), or by non-pulmonary deficits, including respiratory muscle weakness, paralysis, and deformity or rigidity of the chest wall(1).
B.2. Risk factors
1. Second hand smoke and genetic influence
Cigarette smoke not only causes Respiratory Disease, including Restrictive lung disease but also can influence early immune function as a potential to interact with other genetic factors and environmental risk factors to influence disease propensity(10).
Obesity, particularly severe central obesity, affects respiratory physiology both at rest and during exercise as a result of ventilatory defect due to reductions in expiratory reserve volume, functional residual capacity, respiratory system compliance and impaired respiratory system. In the study by National Taiwan University Hospital, showed that obesity may also impair upper airway mechanical function and neuromuscular strength, and increase oxygen consumption, which in turn, increase the work of breathing and impair ventilatory drive. The combination of ventilatory impairment, excess CO(2) production and reduced ventilatory drive predisposes obese individuals to obesity hypoventilation syndrome(11).
African Americans are at higher risk than white race in development of Restrictive lung disease.
As the disease is a result of progression over prolonged period of time, most patients with restrictive lung disease are older than 50 years.
C. Diseases associated with restrictive lung diseases
1. Heart diseases
In the study to explore the association of COPD and restrictive lung function impairment, respectively, with heart diseases in the general population in a cross-sectional study of 642 randomly selected 22- to 72-year-old subjects in northern Swede, found that there is a strong association between COPD and cardiovascular diseases and indicates a strong association between restrictive lung function and heart diseases. Both obstructive and restrictive lung function impairments were common among subjects with heart diseases and vice versa(12).
2. Ulcerative colitis
There is an association between ulcerative colitis and lung disease in which patients have chronic cough and show hyperplastic and inflammatory changes in their bronchial mucosa, according to the study by
Guy’s Hospital and Brook General Hospital(13).
3. Syringomyelia and syringobulbia
There is a report of three patients with syringomyelia and syringobulbia who developed severe respiratory complications. In neurological examination showed evidence of IXth and Xth cranial nerve involvement with dysphagia and dysphonia, but there were no complaints of serious sleep difficulties. Two patients died during sleep and the other was resuscitated during a nap. All patients showed moderate restrictive ventilatory defects with reduced maximal buccal pressures and one also showed a low ventilatory response to CO2 rebreathing(14).
In the study to assess various lung function indices, including C(L,s) and D(L,CO), as markers of functional abnormality in sarcoidosis patients from 830 consecutive patients referred for lung function tests with a diagnosis of sarcoidosis (223 in stage I, 486 in stage II and 121 in stage III), found that
Normal total lung capacity was found in 772 (93%) patients. Of these cases, 24.5% had a low C(L,s) and 21.5% had a low D(L,CO). At least one abnormality was observed in 39.3% of these patients, whereas, in restrictive patients, this figure was 88%. Airway obstruction was present in 11.7% of cases(15).
5. Neuromuscular disease
The earliest sign of respiratory compromise in the patient with neuromuscular disease is nocturnal hypoventilation, which progresses over time to include daytime hypoventilation and eventually the need for full-time mechanical ventilation(16).
6. Other diseases
According to the study by Department of Public Health and Clinical Medicine, Umeå University, in restrictive lung function the prevalence of chronic rhinitis, cardiovascular disease, hyperlipemia and diabetes was higher compared to in Nlf (41.0% vs 32.3%, p = 0.017, 59.0% vs 41.0%, p<0.001, 29.2% vs.12.9%, p = 0.033, 20.9% vs 8.6%, p <0.001). In COPD and heart disease, 62.5% had chronic rhinitis and/or GERD, while in Nlf the corresponding proportion was 42.5%(17).
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